Research Project
azoz1415
study2.pdf
See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/320347112
The Impact of Leadership Effectiveness on the Quality of Health Care Service at
Universiti Sains Malaysia Hospital (HUSM), Kubang Kerian, Kelantan, Malaysia
Article · July 2017
CITATIONS
0 READS
189
1 author:
Some of the authors of this publication are also working on these related projects:
Article View project
Wan Afezah Wan Abdul Rahman
Universiti Sains Malaysia
11 PUBLICATIONS 51 CITATIONS
SEE PROFILE
All content following this page was uploaded by Wan Afezah Wan Abdul Rahman on 12 October 2017.
The user has requested enhancement of the downloaded file.
ISSN 2309-0081 Wan Afezah (2017)
407
I
www.irss.academyirmbr.com July 2017
International Review of Social Sciences Vol. 5 Issue.7
R S S
The Impact of Leadership Effectiveness on the Quality of
Health Care Service at Universiti Sains Malaysia Hospital
(HUSM), Kubang Kerian, Kelantan, Malaysia
Dr. WAN AFEZAH WAN ABDUL RAHMAN School of Distance Education Universiti Sains Malaysia
11800 USM, Penang, Malaysia
E-mail: [email protected]
Tel: 604-653 5947
Fax: 604-657 6000
Abstract
This study aims to discover the impact of leadership effectiveness on the quality of health care service at
the university hospital in Kelantan, Malaysia. The study discussed the impact of leadership effectiveness in
providing a high quality, safe, efficient, and satisfaction to the patients. The research used two types of the
questionnaires: the Leadership Practices Inventory (LPI) survey developed by Jim Kouzes and Barry
Posner (2000) and the Consumer Assessment of Health Care Providers and Systems (CAHPS) which was
developed by the U.S Department of Health and Human Services (1995). The results showed that
leadership effectiveness correlated significantly with service quality. The study showed that the patients are
highly satisfied with the quality of health care service provided by Universiti Sains Malaysia’s Hospital.
Keywords: Leadership, Empathy, Quality, Management, Service.
Introduction
Leadership effectiveness is defined by a leader’s ability to mobilize and influence followers. Leadership
effectiveness depends mostly on the successful and punctual accomplishment of tasks from a leader’s set of
objectives. Leadership effectiveness is pivotal because it determines the success of organizations. This way,
organizations are able to improve their performance by increasing employee optimism, motivation, and
commitment, as well as organizational vision. Leadership effectiveness has been viewed as an important
part in promoting high quality health, reducing costs and improving patients’ satisfaction in health care
services.
The goal of health care services is to promote primary care, improve patient outcomes and improve public
health. Providing high quality and affordable health care services is an increasingly difficult challenge. This
is due to the complexities of health care services as well as systems, costs, quality, delivery, organization
and outcomes of health care services. Effective leadership is crucial for HUSM to maintain its quality
ISSN 2309-0081 Wan Afezah (2017)
408
I
www.irss.academyirmbr.com July 2017
International Review of Social Sciences Vol. 5 Issue.7
R S S
services for patients. This is because the issues of quality in the delivery of health services are critical in
assessing the effectiveness of quality health care and in evaluating health policies.
Background of the Study
There has been great concern regarding leadership effectiveness due to changes in market growth and rapid
globalization (Bailie, 2011). Thus, organizations aim to improve their performance in world markets by
strengthening leadership effectiveness (Noubar, Che Rose, Kumar, & Salleh, 2011; Ventakesh, 2006).
There is little information on understanding the differential impacts of leadership effectiveness on the
quality of health care service at HUSM. The research aims to examine the relationships between leadership
effectiveness and outcomes for the quality of health care service. It will investigate the impact of leadership
effectiveness and quality of health care involving the staff and patients at HUSM. The research will
interview about 353 staff and 361 patients.
Statement of the Problem
We always hear different stories and complaints from patients from different backgrounds from various
hospitals. There has been great concern regarding the quality of health care service at hospitals, especially
government hospitals (Raman, 2008). This is because hospitals have been trying to improve their services
in many ways. Everyday, hospitals and other health care providers face a lot of problems aside from dealing
with patients. These problems include efficiency, management, staffing, logistics, maintenance and others
(Becher & Chassin, 2001). This is because health care providers are facing strong competition due to the
industry's movement towards managed health care systems. In order to create or sustain a competitive
advantage, health care providers are pressured to integrate with modern approaches, which stress leadership
effectiveness and quality of health service outcomes (Choi; Cho; Lee; Lee & Kim, 2002).
Leadership effectiveness plays a pivotal part in making sure that employees perform above and beyond
their abilities in providing the best health care services (Boseman, 2008). In this scenario, with effective
leadership, it can help to improve the quality of health care services at HUSM (Choi et al., 2002). Effective
leadership involves all groups, starting from the top leaders; the board directors to the lower management,
who work at HUSM. Effective leadership and outstanding employee performance is needed in order to set
up an excellent quality of health care service at HUSM so that it will be known for its excellent and
improved services. Thus, the study will explore the impact of leadership effectiveness, improving the
quality and outcomes of health care service.
Objectives of the Study
1. To determine the impact of leadership effectiveness on the quality of health care service at HUSM. 2. To find out if there is a need to increase the quality of health care service at Universiti Sains Malaysia
Hospital (HUSM), Kubang Kerian
3. To find out whether leadership effectiveness effects the employees’ satisfaction at HUSM.
Purpose of the Study
The purpose of the research is to explore the impact of leadership effectiveness toward the total quality of
health care services at HUSM. Specifically, the research aims to increase the likelihood of achieving
desired health care outcomes as expressed by the patients as well as to protect and improve the health of
patients. The purpose of the research is also to improve the quality of health care services as well as clinical
practices and patient outcomes and also to reduce mistakes. The research will serve as an integral part of
ISSN 2309-0081 Wan Afezah (2017)
409
I
www.irss.academyirmbr.com July 2017
International Review of Social Sciences Vol. 5 Issue.7
R S S
quality improvement programs in hospitals, clinics and health plans at HUSM as well as other hospitals.
Accordingly, the research will provide recommendations that may help leaders from HUSM establish the
importance of leadership effectiveness in health care services. Lastly, the study aims to give patients access
to the best possible health care services and resources in Malaysia.
Research Questions
1. Does leadership effectiveness impact the quality of health care service at HUSM? 2. Is there a need to increase the quality of health care service at Universiti Sains Malaysia Hospital
(HUSM), Kubang Kerian?
3. Does leadership effectiveness effect the employees’ satisfaction at HUSM?
Research Hypotheses
To answer the research questions, the following hypotheses will be tested:
H01: There is a significant relationship between leadership effectiveness and quality of health care service at
Universiti Sains Malaysia Hospital (HUSM), Kubang Kerian.
H02: There is a need to increase quality of health care service at Universiti Sains Malaysia Hospital
(HUSM), Kubang Kerian.
H03: Leadership effectiveness does effect the employees’ satisfaction at HUSM.
Significance of the Study
The significance of the research to the domain of leadership effectiveness is important in improving the
quality of services in organizations as it will be of interest to scholars in management and leadership,
specifically to health care providers. The study will extend the knowledge that currently exists in the
literature. This study will also contribute immensely to the current literature by considering leadership
effectiveness as one aspect of the broader scope of health care services.
The study will provide an understanding of the importance of leadership effectiveness toward improving
the practices, procedures, and success of the organization. Additionally, this research will help
organizations to develop leaders who can meet today’s challenges as well as provide better services to
patients. On top of that, the research will help current and future leaders to succeed in their career
development and stimulate future research on similar topics.
By providing quantitative measures of leadership effectiveness and quality health care services, the
research will provide new perspectives on the relationship between leadership effectiveness and the quality
of health care services. This study will make a significant contribution to the field of leadership
effectiveness and quality health care services given that the existing system is unsatisfactory to patients.
Scope of the study
In this research, the main purpose is to investigate the impact of effective leadership on the quality of health
care services at Universiti Sains Malaysia Hospital (HUSM), Kubang Kerian. Thus, the research is focused
on leadership effectiveness and the quality of the health care services at HUSM. This study is only limited
to the staff and in-patients at HUSM.
ISSN 2309-0081 Wan Afezah (2017)
410
I
www.irss.academyirmbr.com July 2017
International Review of Social Sciences Vol. 5 Issue.7
R S S
Literature Review
Leadership is a process of influencing followers in order to achieve a common understanding to perform a
task and reach an organizational goal (Smith, 1996). The concept of leadership gives huge impact on the
theory and practice of organizations (Smircich & Morgan, 1982). This is because without good leadership,
many organizations will be paralyzed and disorganized. Leadership effectiveness is a vital element in
bringing organizations to success because effective leaders understand its impacts and contributions in
improving the quality of organizations (Noubar et al., 2011). Yusof and Bhattasali (2008) point out that
effective leadership has played an important role in bringing organizations closer to global standards.
Effective leadership provides leaders with skills, so that they are able to have a clear picture to meet the
challenges of the environment and create significant change in order to meet organizational goals (Center
for Creative Leadership, 2010).
McCuddy and Cavin (2008) noted that effective leaders know how to adapt to multicultural differences,
have exceptional knowledge of business operations, have effective time management skills, and be able to
act and think beyond traditional boundaries. Additionally, being an effective leader requires the ability to
take the perspective of others (McCormick, 1999). McCormick further notes that the ability to take the
perspective of others means that leaders should be able to see the world through others’ eyes.
According to Puvarattanakul and Muenjohn (2009), leaders are responsible for the success or the failure of
their organizations. Thus, to achieve their objectives and goals, the organizations must have effective
leaders, who can influence employees to work towards achieving those objectives and goals in an efficient
way. On the same note, effective leaders initiate the necessary changes in business organizations to achieve
these goals. According to Toremen Toremen, Ekinci, and Karakus (2006), a leader who wants to be
effective must employ human touch, which means using empathy in all of his or her leadership actions.
Geller (2000) noted that, effective leadership can be accomplished through empathy, regular
communication, and good interpersonal skill with employees. These criteria will help effective leaders to
give clear directions and help employees to rise above and beyond organizational practices to accomplish
difficult tasks. Effective leadership plays a vital role in sustaining the success of quality health care service.
Effective leadership is seen as a process of unifying people, developing cohesive skills, innovating, and
having supportive relationships with the people around them. These types of leaders also help people to
mobilize change (Essays, 2013).
Being effective leaders means these leaders involve everyone at every level of the organization. They know
the best approach for their staff and are able to guide them closer towards their vision. These leaders are
empathic, have shown a strong commitment, and are able to lead by example, inspiring and supporting their
teams. These leaders have also shown to be strong role models for the beliefs and values they hope others
will adopt. In a health care environment, these types of leadership skills are very important in terms of
quality. A study showed that leadership has a visible affect on the quality of patients’ health care
(Mowbray & Firth-Cozens, 2001).
Over the years, quality has become core to our daily lives. Improving the quality of health services has
become a primary concern for patients. In health care services, improving patient and employee satisfaction
leads to favorable results, positive word of mouth and positive affects of medical outcomes (Choi, 2002). In
order to provide satisfaction to patients, quality service has become increasingly important for hospitals.
Juran (1988) said that quality service nurtures customers’ confidence and is very important for a
competitive advantage. Quality also means enhancing effiency, reducing mistakes and reducing costs
(Mowbray & Firth-Cozens, 2001). Previous research states that effective leadership is positively associated
ISSN 2309-0081 Wan Afezah (2017)
411
I
www.irss.academyirmbr.com July 2017
International Review of Social Sciences Vol. 5 Issue.7
R S S
with higher employee satisfaction and better performance and would thus improve public health care
services (Essays, 2013).
Quality service is reflected in today’s health care centers in a wide variety (Choi, 2002). Quality service
refers to clinical outcomes, services received by the patients that make a medical difference in the lives of
the patients . These medical treatments can include everything from doctor’s appointments, consultations,
treatments, procedures, and medications (Hughes, 2008). Service relates to what the medical staff can do to
make the patients’ experience better and make them feel good. Choi et al. (2002) also noted that quality
service is an important ingredient of the success of an organization based on its primary role of achieving
patient satisfaction. These include communication, response, amenities, level of empathy and the quality of
the care that they receive. The research will be determined based on three basic elements, which include the
contribution of leadership effectiveness, the quality of the service, and the satisfaction of patients and staff
of HUSM.
Leadership effectiveness and quality health care service are two essential elements in increasing the
likelihood of achieving desired health care outcomes. These elements play an imperative role in promoting
the health care of the general public and reducing potential threats to health such as infectious diseases and
environments. Furthermore, improving the quality of health care services has became as top priority on the
list of hospitals and government agenda. These elements will enhance the chances of patients getting access
to the best possible health care services and resources in Malaysia.
Methodology
The study was conducted at the teaching university known as “Hospital Universiti Sains Malaysia”
(HUSM) located in Kubang Kerian, Kelantan, Malaysia. The researcher visited in-patients and employees
at the hospital to distribute the questionnaire. The researcher met the in-patients and staff individually and
explained the purpose of the research. The research was using a quantitative method. The study used a
cross-sectional research design. In this case, it used two types of survey instrument. To measure leadership
effectiveness for the doctors, nurses and administrations, the research was using the Leadership Practices
Inventory (LPI) survey developed by Jim Kouzes and Barry Posner (2000). For the in-patient survey, the
research was using a widely used questionnaire, the Consumer Assessment of Health Care Providers and
Systems or CAHPS. CAHPS is developed by the U.S Department of Health and Human Services (1995).
Mrs. Nor Aini from Universiti Sains Malaysia’s Language Center has validated the instruments that will be
used in the research. The research will be done by selecting doctors, head nurses and administrators and in-
patient groups from the selected wards. Survey questionnaires were used to obtain information on patients’
and employees’ satisfaction in health care plans.
Sample
The sample consisted of hospital staff and patients who received inpatient services from different wards.
This sample size is selected based on the top five wards that received the highest amount of patients. The
selected wards are the female medical ward, the male medical ward, antenatal wards, and the male surgical
ward. The sample was categorized as a non-interventional study. It was a purposive sampling which
focused on a selected group in order to answer the research questions.
Vulnerability/Protection of participants’ rights
The patients and staff who were willing to participate in this study are protected according to the federal
requirements specified by the Department of Health and Human Services’ Code of Regulations,
ISSN 2309-0081 Wan Afezah (2017)
412
I
www.irss.academyirmbr.com July 2017
International Review of Social Sciences Vol. 5 Issue.7
R S S
IRB00004494. Accordingly, the research protocol for the study was reviewd by the University Sains
Malaysia Research and Ethical Committee. The study strictly follows all the guidelines needed in order to
protect participants’ rights and vulnerability. The researchers are committed to follow all the guidelines. As
participants, they:
1. Have enough time to decide whether or not they wish to be in the research study and to make that decision without any pressure from the people who are conducting the research.
2. Can refuse to be in the study and/or to stop participating at any time. 3. Will be told what information the study is attempting to attain, and what they will be asked to do in the
study.
4. Will be told about the reasonably foreseeable risks of being in the study. 5. Will be told about the possible benefits of being in the study. 6. Will be told whether there are any costs associated with being in the study. 7. Will be told who will have access to the information collected and how their confidentiality will be
protected.
8. Will be told whom to contact with questions about the research and about their rights as a research subject.
9. The participants will not be asked to write down their names on the survey form. 10. Staff group- only for those who are working at the selected wards. Privacy and confidentiality will be
guaranteed. It will definitely have no effect in the yearly performance.
Sample size calculation
According to Glenn D. Israel (2015), for the purpose of the study and population size, three criteria are
needed to determine the appropriate sample size. The criteria are: the level of confidence, the level of
precision, and the degree of variability in the attributes being measured. In this study, for the level of
confidence , a 95% confidence level is selected. The level of precision, also known as sampling error, is ±5
percent (100-95%), which is the range the true value of the population is estimated to be. The degree of
variability is 0.05, which indicates the maximum variability in a population. Each of these are reviewed
below:
N = N is the population size.
e = the level of precision.
The total number of the participants was 805. Out of 805, 407 were HUSM staff and 398 were patients.
Statistical and Data Analysis
Data Collection
The data will be collected at one time point within one to two weeks. The researchers will visit the selected
wards and explain the study to the participants. After brief interviews with the patients and staff, the
participants will complete the survey form. The patients will complete the CAHPS survey and the staff will
ISSN 2309-0081 Wan Afezah (2017)
413
I
www.irss.academyirmbr.com July 2017
International Review of Social Sciences Vol. 5 Issue.7
R S S
complete the LPI survey form. The surveys will use the 5-point Likert Scale, where 1 = Strongly Diagree
and 5 = Strongly Agree. The collected data will be labelled and stored in a secured file by the primary
researcher to ensure confidentiality.
The Result
The preliminary analysis was conducted which included the frequency analysis, factor analysis, reliability
analysis and descriptive analysis. Frequency analysis is used to gather information on the respondents’
profile, factor analysis and reliability analysis is conducted to measure the reliability and quality of the
instrument used in this study while descriptive analysis is conducted to examine the respondents’
perceptions toward the variables of the study (leadership effectiveness and service quality).
Profile of HUSM Employees
The result showed that the majority of the HUSM employees who participated in this study are female
(69.5%). Most of them are from 26 to 35 years old (42.9%). Out of 406 respondents, the majority of them
are Malay (92.9%), followed by Chinese (5.9%), others (1%) and Indian (0.2%). As for educational
qualification, the majority of the respondents have a high school diploma and associate degree or equivalent
(43.8%).
Profile of HUSM Patients
The result showed that most of the HUSM patients involved in this study are female (73.2%). The majority
of them are from 26 to 35 years old (33.2%). Out of 396 respondents, the majority of them are Malay
(92.9%), followed by Chinese (3.7%), Indian (0.5%) and others (0.2%). As for educational qualifications,
the majority of the respondents have a high school diploma or equivalent (44.6%).
Referring to Table 1, the KMO value of 0.927 and the significant result of Bartlett’s Test of Sphericity
shows that the data did not have multicollinearity problems and the correlation between the items is
sufficient to perform the factor analysis.
Table 1: KMO and Bartlett’s Test
Kaiser-Meyer-Olkin Measure of Sampling Adequacy. .927
Bartlett's Test of Sphericity Approx. Chi-Square 6769.810
df 351
Sig. .000
The study has two variables which were leadership effectiveness as the independent variable and service
quality as the dependent variable. The results of the reliability analysis in Table 2 indicated that both
variables have good and strong Cronbach’s Alpha values which was more than .90. This result shows that
the instrument used in this study is reliable.
Table 2: Reliability Analysis
Variable Cronbach’s Alpha No. Of Items
Leadership Effectiveness .944 13
Service Quality .933 14
The results showed that leadership effectiveness was correlated significantly with the service quality (p <
0.05). However, the relationship between the two variables is very weak (r = 0.103). In Table 3, leadership
effectiveness, service quality as well as overall service quality was perceived as high by the respondents.
ISSN 2309-0081 Wan Afezah (2017)
414
I
www.irss.academyirmbr.com July 2017
International Review of Social Sciences Vol. 5 Issue.7
R S S
Table 3: Mean Scores and Standard Deviation for the Study Variables
Variables Mean Standard Deviation Results
Leadership Effectiveness 4.24 0.545 High
Service Quality 4.31 0.550 High
Overall Score of Service Quality at HUSM 8.17 1.467 High
The patients were asked to indicate their perception towards HUSM overall service quality based on the
scale from 1 (very low) to 10 (very high). The result showed that 99.2%, majority of respondents were
satisfied with the services. Very little chose lower than scale 5 (0.8%).
The Spearman’s Rho Correlation analysis was conducted in the study. The results showed that leadership
effective correlated significantly with service quality (p < 0.05). However, the relationship between the two
variables is very weak (r = 0.103). Based on the result of simple linear regression, the result showed that
there is no relationship between the independent variable (Leadership Effectiveness) and dependent
variable (Service Quality). This showed that there are other predictors that affect the quality of services at
HUSM.
Conclusion
Leadership effectiveness is an important tool for organizations in order to inspire, mobilize, communicate
and motivate their followers to reach the organizational goal. Leadership effectiveness means great leaders
with certain skills do what it takes to accomplish any goals that they set in their minds in order to improve
the quality of the services for the benefit of the staff, the customers and the organization itself. Quality of
health care service relates to promoting and enhancing health care services, increasing efficiency and
patient outcome, and reducing mistakes and costs.
This study revealed that the employees perceived their leader to have high leadership values especially in
terms of encouraging a sense of cooperation in the workplace, treating the employees with respect and
courtesy and having a good relationship in the workplace. Meanwhile, the HUSM patients reported that
they received high quality healthcare service from the HUSM staff especially in terms of professionalism
and great attitude of the HUSM staff, satisfaction with the treatment given and things being explained in a
way that is easily understood. Based on the correlation analysis, this study found that there is a correlation
between leadership effectiveness and service quality. However, the relationship is very weak.
Acknowledgement
The author would like to thank Universiti Sains Malaysia for making the research possible under The
Short-Term grant (Grant no. 304/PJJAUH/6313205).
References
Abujarad, I. Y. (2011). The impact of personality traits and leadership styles on leadership effectiveness of
Malaysian managers. Academic Leadership, 9(2),70-99.
Becher E. C., & Chassin, M. R. (2001). Improving the quality of health care: Who will lead? Health
Affairs, 20(5), 164-179.
Center for Creative Leadership, (July, 2010). Addressing the leadership gap in health care: What’s needed
when it comes to leader talent? Center for Creative Leadership, 3-19.
ISSN 2309-0081 Wan Afezah (2017)
415
I
www.irss.academyirmbr.com July 2017
International Review of Social Sciences Vol. 5 Issue.7
R S S
Choi, Kui-Son; Cho, Woo-Hyun; Lee, Sun Hee; Lee, Hanjoon., & Kim, Chankon (2002). The relationships
among quality, value, satisfaction and behavioral intention in health care provider choice: A South
Korean study. Journal of Business Research, 57, 913-921.
Cicero, L., Pierro. A., & Van Knippenberg, D. (2010, June). Leadership and uncertainty: How role
ambiguity affects the relationship between leader group prototypicality and leadership effectiveness.
British Journal of Management, 21(2), 411-421.
Cronin Jr, J. J., Brady, M. K., & Hult, G. T. (2000). Assessing the effects of quality, value, and customer
satisfaction on consumer behavioral intentions in service environments. Journal of Retailing, 76(2),
193-218.
Davis, M. H. (1983). Measuring individual differences in empathy: Evidence for a multidimensional
approach. Journal of Personality and Social Psychology, 44(1), 113-126.
Essays, UK. (November 2013). Effective Leadership In The National Health Service Management Essay.
Retrieved from https://www.ukessays.com/essays/management/effective-leadership-in-the-national-
health-service-management-essay.php?cref=1
Firth-Cozens, J. & Mowbray, D. (December 2001). Leadership and the quality care. Quality in Health
Care, 10(2), ii3–ii7.
Geller, E. S. (2000). Empathic leadership. Retrieved February 5, 2011 from Safety Performance Solutions
Web Site: http://www.safetyperformance.com/pdf/Articles/2000/EmpathicLeadership.pdf
Hughes, R. G. (2008). Patient safety and quality: An evidence based handbook for nurses. Rockville, MD:
Agency for Health care Research and Quality (US).
Israel, G. D. (2015). Determining sample size. Retrieved April 11, 2016 from University of Florida website
https://edis.ifas.ufl.edu/pdffiles/PD/PD00600.pdf
Juran, J. M. (1988). Planning for Quality. New York: Free Press
Kouzes, J. & Posner, B. (2001). Leadership Practices Inventory (2nd ed.). San Francisco: Jossey-Bass.
Liethwood, K. A., & Riehl, C. (2003). What we know about successful school leadership. Philadelphia, PA:
Laboratory for Student Success, Temple University.
Noubar, H., Che Rose, R., Kumar, K., & Salleh, L. (2011). Learning culture to organizational
breakthroughs in Malaysian companies. Economics & Management, 16(1), 852-858.
Marques, J. (2010, Fall/Winter). Spirituality, meaning, interbeing, leadership, and empathy: Smile.
Interbeing, 4(2), 7-17.
McCallum, S., & O’Connell, D. (2009). Social capital and leadership development: Building stronger
leadership through enhanced relational skills. Leadership & Organization Development Journal, 30(2),
152-166.
Oliver, R. L. (1997). Satisfaction: A Behavioral Perspective on the Customer. Boston, MA: Irwin-McGraw-
Hill.
Puvarattanakul, S., & Muenjohn, N. (2009). Leadership personality traits and satisfaction, effectiveness and
productivity. International Business Academics Consortium, 5(1), 1-7.
Smircich, L. & Morgan, G. (1982). Leadership: The management of Meaning. The Journal of Applied
Behavioral Science, 18(3), 257-273.
Smith, R. A. (Winter, 1996). Leadership as Aesthetic Process. Journal of Aesthetic Education, 30 (4), 39-
52.
Toremen, F., Ekinci, A., & Karakus, M. (2006). Influence of managers’ empathic skills on school success.
International Journal of Educational Management, 20(6), 490-499.
U.S. Department of Health and Human Services (1995). The Consumer Assessment of Health Care
Providers and Systems (CAHPS). Retrieved on Feb 18, 2014 from https://www.cahps.ahrq.gov/about-
cahps/cahps-program/index.html.
Yusof, Z. A., & Bhattasali, D. (2008). Economic growth and development in Malaysia: Policy making and
leadership. The International Bank for Reconstruction and Development/The World Bank. Retrieved
from http://www.growthcommission.org/storage/cgdev/documents/gcwp027web.pdf
View publication statsView publication stats
